Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.71 / $23.22 / $27.95	Facility	26	$16.71	$23.22	$27.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $61.01 / $385.02 / $622.38	Facility	TC	$61.01	$385.02	$622.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.56 / $87.00 / $347.40	Professional		$34.56	$87.00	$347.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.65 / $27.36 / $126.72	Professional	26	$10.65	$27.36	$126.72
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $124.11 / $361.94 / $740.00	Professional	50	$124.11	$361.94	$740.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $20.14 / $24.58 / $46.33	Professional	52	$20.14	$24.58	$46.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.57 / $65.72 / $237.49	Professional	TC	$31.57	$65.72	$237.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.70 / $92.01 / $257.50	Professional		$41.70	$92.01	$257.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.78 / $24.16 / $67.31	Professional	26	$10.78	$24.16	$67.31
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $61.58 / $148.63 / $414.16	Professional	50	$61.58	$148.63	$414.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.14 / $67.27 / $196.92	Professional	TC	$30.14	$67.27	$196.92
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.31 / $42.08 / $63.93	Professional		$12.31	$42.08	$63.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $33.70 / $44.79	Facility	26	$28.84	$33.70	$44.79
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $100.02 / $116.89 / $155.35	Facility	TC	$100.02	$116.89	$155.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.48 / $166.09 / $188.74	Professional		$44.48	$166.09	$188.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $39.08 / $44.41	Professional	26	$12.86	$39.08	$44.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.78 / $127.01 / $144.33	Professional	TC	$32.78	$127.01	$144.33
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $251.00	Facility	26	$100.00	$100.00	$251.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $165.02 / $434.44 / $665.98	Facility	TC	$165.02	$434.44	$665.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $46.56 / $114.04 / $297.63	Professional		$46.56	$114.04	$297.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.19 / $35.77 / $100.80	Professional	26	$13.19	$35.77	$100.80
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.14 / $79.89 / $229.42	Professional	TC	$33.14	$79.89	$229.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $40.15 / $77.04	Professional		$19.34	$40.15	$77.04
Quartz Facility/Professional Professional Modifier Low / Median / High Price $92.30 / $127.08 / $170.04	Professional		$92.30	$127.08	$170.04
Quartz Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Quartz Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $165.02 / $165.02	Facility	TC	$100.00	$165.02	$165.02
Quartz Facility/Professional Professional Modifier Low / Median / High Price $69.95 / $210.40 / $297.63	Professional		$69.95	$210.40	$297.63
Quartz Facility/Professional Professional Modifier 26 Low / Median / High Price $18.11 / $55.70 / $87.52	Professional	26	$18.11	$55.70	$87.52
Quartz Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $155.30 / $229.42	Professional	TC	$53.50	$155.30	$229.42
Security Health Facility/Professional Professional Modifier Low / Median / High Price $85.39 / $261.62 / $295.99	Professional		$85.39	$261.62	$295.99
Security Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $31.35 / $65.05	Professional	26	$24.78	$31.35	$65.05
Security Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.62 / $60.61 / $185.18	Professional	TC	$54.62	$60.61	$185.18
United Facility/Professional Professional Modifier Low / Median / High Price $44.32 / $91.91 / $184.42	Professional		$44.32	$91.91	$184.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.95 / $25.66 / $48.83	Professional	26	$11.95	$25.66	$48.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.84 / $64.15 / $135.59	Professional	TC	$32.84	$64.15	$135.59